I had grade III shoulder separation two weeks ago. As a hobby I lift weights actively. E.g. I have made 400 in bench press, 330 in incline bench press and 240 in military press. I think I try to rehabilitate the shoulder first without surgery.

Does somebody have experiences of how well it is possible to recover the original strength level after this injury?

How much time it is going to take to recover fully?

Does the separation cause some kind of permanent unfunctionality to the shoulder so that it is not possible to gain the original strength level back?

Should surgery help the recovery?

I have read few studies of how recovery has gone after this injury and it seems that without the surgery the recovery process is faster and you are able to gain the original strength level quite well back. But I understood that those studies were made with patients that didn't lift weights actively.

injuryupdate

25-08-2004, 03:26 PM

If by shoulder separation you mean A/C joint then usually conservative treatment is recommended over surgery. If you have dislocated the entire shoulder, maybe surgery is required.

Grade 1-2 A/C joint injuries should definitely be treated surgically and grade 3+ (or 4-6) where the clavicle has ended up way out of place should be treated surgically. Grade 3 injuries, where the clavicle part of the A/C is displaced a long way but upwards only (and not sideways or backwards) are controversial as to whether surgery or conservative is best. I will try to treat without surgery in football players. Probably trial of conservative is best as many recover well without surgery and also surgery can be performed later on with success.

However, if you are obsessive about lifting PBs, perhaps getting an anatomic repair may be advisable. If I was treating an Olympic weightlifting I think I would advise repair after a grade 3 injury, perhaps same with pro tennis player or Olympic swimmer (who don't tend to suffer this injury anyway) but for most other athletes go conservative at first.

My injury seems to be "Grade 3 injury, where the clavicle part of the A/C is displaced a long way but upwards only."

I think I would be happy if I could rehabilitate my shoulder so that I could even lift weights with using more bodybuilding style. E.g. to make longer sets with 80% of 1RM. Of course the injured shoulder would be weaker also in this kind of training.

In one study of conversatively treated grade 3 A/C joint injuries, it was mentioned that although in general strength recovered well to the injured shoulder, bench press caused problems. Non athletic patients had in average 17% weaker "bench press" strength in their injured shoulder compared to their uninjured shoulder.

I haven't found any studies of how bench press results have been able to recover with surgical treatment of this kind of injury. Do you know any or do you know any real life examples?

If the shoulder recovers to almost its original strength with conversative treatment, are there any exercises that should be avoided?

Somewhere it was mentioned that heavy dips should be avoided. But what about dead lifts, pull ups etc.

I understand that I must handle the actual rehabilitation with local orthopedist and physical therapist. They also recommended to try first conversative treatment. But it helps a lot to get a second opinion.

sydunisportsmed

26-08-2004, 11:00 AM

You are right with this correction - should be non-surgical. Although general patterns can be followed, each A/C injury is different, so see how you pull up and if you are not too bad, avoid surgery, but if you have chronic pain or weakness, discuss it with an orthopaedic surgeon.

andre

11-09-2005, 06:06 AM

Mikexxx, I am in the same position you are, I have a grade three separation and would like to return to doing heavy bench press, etc. I was wondering how your shoulder has been doing, did you get the surgery? I am currently considering an operation.

Cookie

02-12-2005, 04:04 AM

Hi, i too had a grade 3 shoulder seperation a year ago. I resumed weightlifting after 4 months but still had a problem with bench press and pull downs. Even simple movements such as bi cep curls were affected as the whole shoulder is unstable and moves out of symmetry when compared with the other.

I had surgery a week ago and am waiting to see the results. Its a hard decision to make as my shoulder didn;t bother me during normal activities and it was only when lifting weights. I realise it could go either way but decided it was worth the risk.

I'll keep u posted on my progress

take it easy

cookie

plucs

02-12-2005, 10:39 AM

Hi Cookie,

I was in the same situation as you at one year post my grade 3 ac joint dislocation. Later in the second year is when I developed chronic pain. Chronic pain for me was pain in most days of the week at varying levels with the worst forcing me to not move my shoulder.

I also had surgery, outer clavicle excision modified weaver dunn shoulder reconstruction on the 22 September 2005. I wish I had the surgery earlier so I believe you made the right decision.

In terms of results you won't really know until you take your arm out of the sling in week 6. I would not stress too much before week 6 as your orthopaedic surgeon will have fixed the structural problems in your shoulder. It is easy to stress but you will be doing yourself no good. Just protect your shoulder and watch a lot of TV, DVDs, read and keep relaxed in the first 6 weeks.

In week two you will get your stitches out. If your wound has not healed fully when the stitches come out make sure you pay careful attention to it. If the wound is not healing you should expect to visit your GP for advice and possibly antibiotics to clear up the wound. The immediate results of the operation will be a vertical scar running across the top of the end of your clavicle. It should be around 3.5 - 4 inches. Your clavicle will be better aligned so there will be a large reduction in any bump.
In week 6 when you get your shoulder out of the sling there will be a lot of muscle wastage around your shoulder and bicep since you will not have moved your arm for 6 weeks. Your shoulder will not move very much as the shoulder becomes compartmentalised. You can compare this will the mobility you have in your good shoulder if you attempt to move it in the direction of the compass points. After week 6 your shoulder will improve daily but it will take a lot of work on your part to keep moving. You will need to find an experienced physio who has worked with similar repairs. Expect to work very hard on your rehab. You will initially focus of your range of movement and then strength.

I wish you all the best mate. Just be sensible and remain positive.

Hi, i too had a grade 3 shoulder seperation a year ago. I resumed weightlifting after 4 months but still had a problem with bench press and pull downs. Even simple movements such as bi cep curls were affected as the whole shoulder is unstable and moves out of symmetry when compared with the other.

I had surgery a week ago and am waiting to see the results. Its a hard decision to make as my shoulder didn;t bother me during normal activities and it was only when lifting weights. I realise it could go either way but decided it was worth the risk.

I'll keep u posted on my progress

take it easy

cookie

Cookie

06-12-2005, 05:59 AM

Thaanks for the advice.
The operation i had was to have the end of the collarbone removed and then plated into position with a wolter hook plate. This has to remain in for 16 weeks. Apparently during this time scare tissue will form and hold it all in place. The thing that worries me is that the torn ligaments were not repaired as in weaver-dunn. I'm now concerned that once the plate is removed it could just move out of place.

Has anyone else heard of this type of surgery?

I suppose it could be an option to get another surgeon to repair the ligaments whilst the plate is still in but this means another operation, which i'm not too keen on but could be worth getting a second opinion.

This is all very annoying since i was originally told it was just a sprain and would heal to full strength by itself.

Still have to soldier on!!

plucs

06-12-2005, 10:56 AM

I will look into this further but i think the wolter hook operation and weaver dunn reconstruction differ in the suturing of the transferred ligaments. Weaver Dunn uses a bosworth screw whereas the wolter hook uses a hook plate. I don't know if it can be said that either technique is better at suturing the ligaments but the bosworth screw degrades away so does not need a second operation to remove it, whereas your plate will be removed in the 16th week. I'm sure you will be fine anyway since you got through the first open shoulder reconstruction.

16 weeks should be plenty of time for there to be sufficient scar tissue to form. My orthopaedic surgeon had a go at me in my 6th week telling me my shoulder is all healed and that I need to start moving and not protect it. Similarly the physio that is handling my rehab had to remind me in the 7th week to not be so protective of my shoulder since significant force like a car accident or a serious fall would be needed to disrupt the repair. Now your repair will be proteccted by a suture for 16 weeks so I can't see how the scar tissue will not be there since the scar tissue in my shoulder which will replace the bosworth screw was there in at least 6 weeks and left to its own in 8 weeks.

The sprain is the same bullshit I got from the hospital physicians and physios initially.

Good luck.

Thaanks for the advice.
The operation i had was to have the end of the collarbone removed and then plated into position with a wolter hook plate. This has to remain in for 16 weeks. Apparently during this time scare tissue will form and hold it all in place. The thing that worries me is that the torn ligaments were not repaired as in weaver-dunn. I'm now concerned that once the plate is removed it could just move out of place.

Has anyone else heard of this type of surgery?

I suppose it could be an option to get another surgeon to repair the ligaments whilst the plate is still in but this means another operation, which i'm not too keen on but could be worth getting a second opinion.

This is all very annoying since i was originally told it was just a sprain and would heal to full strength by itself.

Still have to soldier on!!

plucs

11-01-2006, 08:53 AM

Hi,

I am now at 3.5 months after surgery. My orthopaedic surgeon has told me I can return to Judo in another month. I have regained my range of movement. My external roatation strength on my operated shoulder is less than my uninjured shoulder otherwise my strength is satisfactory. My physio has told me that I can now return to the gym and start working on getting back my swimming stroke.

I told my physio about some discomfort and stiffness around my ac joint and in my deltoids if I do not move my operated shoulder for some time. He told me that it is due to swelling in the tissue as a consequence of the operation and will settle down over the next 3 months.

I am not in pain anymore and am looking forward to the future.

jlb

18-04-2006, 02:22 AM

Hi plucs

I had a grade IV separation on 2nd June 2005 - I seem to go through phases of pain and none pain - the most annoying thing is sometimes when I move my shoulder it tends to grind/click (though not painful) and am wondering whether or not to have surgery.... how are you now? Also if the bump on your shoulder has gone with the surgery?

If anyone else is in a similar position it would be great to hear from you.... there is so much information on the internet about arthritis in the future etc... not sure what to do for the best???

Thanks
jlb

Hi,

I am now at 3.5 months after surgery. My orthopaedic surgeon has told me I can return to Judo in another month. I have regained my range of movement. My external roatation strength on my operated shoulder is less than my uninjured shoulder otherwise my strength is satisfactory. My physio has told me that I can now return to the gym and start working on getting back my swimming stroke.

I told my physio about some discomfort and stiffness around my ac joint and in my deltoids if I do not move my operated shoulder for some time. He told me that it is due to swelling in the tissue as a consequence of the operation and will settle down over the next 3 months.

I am not in pain anymore and am looking forward to the future.

plucs

18-04-2006, 06:59 PM

My shoulder is getting towards where I want it slowly. I have full range of movement and no pain any more. I can even sleep on my side (no more pillow under my arm). I still have not regained my strength but I feel in much better shape after the operation. I'm swimming, weight training and training in judo. The difference pre and post surgery for me is massive. My regret is that I did not have the operation when the warning signs (onset of pain, crunching, moving the arm difficult) started at around 6 months after the injury.

The bump is gone and replaced by a thick 3 - 4 scar perpendicular to the ground across the AC joint. I also had the end of clavicle excised so it is a little shorter than the undamaged side.

My advice would be to see several orthopaedic surgeons who specialise in shoulders. This site has lists of very good orthopaedic surgeons specialising in shoulders. If your work or sports involve a lot of repetitive lifting above your head you would be certainly be a candidate for surgery.

You can email me if you want to talk further.

Gareth

22-05-2006, 10:40 AM

Hey guys,

Thanks for all the emails posted, I have had a simular operation to what some of you have had only I have had a false ligament pinned in between the joint which remains in, and is helpful to get you bac to sport quickly. I had a type III to IV injury playin rugby, and like most of you the docter told me it was a 'sprain' at first. Like some of you I like weight lifting and have got an addiction to bench press. Pre operation I had waited eight weeks to assess conservative treatment but bench press was impossible and I was so paranoid that my shoulder was not attached to my body. I had to have the op through depression as much as anything else as I had lost approximately half a stone of muscle in this time, that it took me about 18 months to gain. I had the op on my 20th birth now 2-3 weeks on still in a sling I am itching to see what it can do but after reading the forum I am going to wait till I have had about six to allow tissue to form etc. My doctor told me to do this anyway but I am now waiting to ensure the best recovery. The progress made by some of you really encouraging and really gives me confidence for my rehab.

Gareth

Charlene

01-06-2006, 09:30 AM

Hi,

I just separated my shoulder last week. I went through the whole dislocation thing on the other side a few years back but this seems way worse. Painful! And my whole arm is like hanging 2 inches lower than the other. Is this normal??? Will it go away???

My doc's on vacation and the fellow thought I was okay, only a 3-, but he didn't even look at my good shoulder for comparison. Am I being too paranoid about where my arm is? I feel like having the sling hold it up will help it heal in the right spot, but the fellow thought I should be without sling by this weekend. I can do it, but it starts to ache like crazy.

And man, I do NOT want to have surgery... I ride horses competitively and I can't take a long break. What is the rehab time if you do have surgery? Will it really hold up anyway? I have a tendancy to fall from height, at speed and land on my shoulders!

Charlene

plucs

02-06-2006, 09:19 AM

Hi,

I just separated my shoulder last week. I went through the whole dislocation thing on the other side a few years back but this seems way worse. Painful! And my whole arm is like hanging 2 inches lower than the other. Is this normal??? Will it go away???

My doc's on vacation and the fellow thought I was okay, only a 3-, but he didn't even look at my good shoulder for comparison. Am I being too paranoid about where my arm is? I feel like having the sling hold it up will help it heal in the right spot, but the fellow thought I should be without sling by this weekend. I can do it, but it starts to ache like crazy.

And man, I do NOT want to have surgery... I ride horses competitively and I can't take a long break. What is the rehab time if you do have surgery? Will it really hold up anyway? I have a tendancy to fall from height, at speed and land on my shoulders!

Charlene

The way your shoulder looks now will never change.

Go see a shoulder specialist - a good orthopaedic surgeon and no one else. You will get all your answers there. A GP and emergency room doctor know nothing about a shoulder separation, except the automatic sling for 2 to 4 weeks. Physios see a lot of shoulder separation and will recommend the conservative approach you say you want.

With surgery my rehab was 3 months with a return to contact sport at 4 months. My shoulder has held up in Judo which is very demanding on the shoulder with the standing throws and ground work.

Unregistered

07-06-2006, 06:51 AM

hey, I suffered a grade three dilocation of my collar bone at the AC joint fifteen weeks ago (got dumped playing rugby), it was the most pronounced one that the paramedics had ever seen. It is still visably out of place (physio said it will neva go back to normal) but I have a full range of painless movement, I play tennis regularly and it causes me no trouble at all.

It does however start to ache intensely (too much to just ignore and just carry on) when i free weight bench press weights 20kg+ (on each arm). On the fixed bench press i can lift 50kg without it aching much at all. Previously my max press was 80kg, i havnt attempted lifting anything this heavy after the dislocation. I am maily lifting to tone and hope to start build up the weights in the next few months.

The joint is stable for bicep curls (18kg, i dont curl higher but not due to the injury), pull ups and dips.

My physio says to build up as much muscle as possable around the joint so that i can go back to playing rugby with reduced chances of redislocation.
Hope this has helped
George,UK

Gareth

08-06-2006, 10:24 AM

Hey George,

You seem to have done something simular to me, the doctors were amazed at my injury as well they even gathered round to look at the x ray which at the time was a bit worrying. It seems as though you have possibly got a bit stronger joint than I had post injury and it is encouraging to see that you have got back to tennis and the gym. With regards to your weights bench press was a real problem for me post op with even 40kg being painful which is a drop from 110kg which I could do before. I think we probably differ in respect that my priority is getting back my gym strength rather than playing rugby as I would prefer to get back to normal and not risk this happening again. You seem to be listening to your physio which is cool and they are telling you the same as mine are, the stronger the muscles are around it the better the joint will be. I am now five weeks after the operation and it is feeling pretty good my bump is almost unoticable and I can feel a lot more stability at the joint. Progress is good to as I can do most daily tasks but I am not allowed to lift anything yet not even a bag or anything as I am still in the first six week healing period. Thanks for filling me in on your progress I will try and keep you filled in on mine, coz if it is one thing I have been glad of while injured it is reading about other people's experiences I just wish there were more to read. Charlene I dont think your bump will dissappear at all but as George said his is getting stronger anyway so it just depends on your priorities as to whether you have your op, but as plucs said go see a shoulder specialist otherwise you will get fobbed off with the same generic answers whether they are applicable or not.

Charlene

10-06-2006, 04:59 AM

So, I'm two weeks out since I separated the shoulder and it still aches a lot and I can only move the arm about half as much as normal. Is this to be expected? I am not normally whinny (have torm my acl and dislocated the other shoulder etc), but this one seems like it hurts more and longer than anything else I've done. Just curious if this is normal.

I got a lecture from my physical therapist about the difference between being determined and being smart. Hmmm. He also said this isn't a no pain no gain thing, there should be no pain when doing my exercises. Sound right? I think he means no aching, 'cause I don't usually have pain per se, but it will ache like nuts.

I've got a good ortho doc, he only does shoulder and knees. BUT, after I went and saw his nurse and the fellow (ortho in training) since my doc was on vacation, I am told I don't need to be seen until week 4. I guess this is okay since I am told they mostly don't do surgery... Is there anything else he'd do anyway or any reason I should whine and get in earlier?

Thanks all.

Charlene

Unregistered

10-06-2006, 07:02 AM

I had a grade 3 separation a few years ago. I didn't have surgery and it took about 8 months to start light weight training again. Now that's it's been 3.5 years since the injury and I still have crepitis (non-painful clicking) in the joint, but I have been fully active for almost 2.5 years. I am back to full strength from before the injury. I took it very slow and cautious while healing. I don't know if surgery would have sped anything up or slowed it down.

This injury was the most painful and lengthy injury I've ever encountered. I think it is normal for there to be lots of pain and limited range of motion for several months after this injury. I think it took nearly 2 months to be able to dress myself without pain. I chose not to have the surgery and am happy I didn't. The doctor I talked to felt that unless it wasn't healing on its own, there was no reason to cut.

Marc

13-06-2006, 07:31 AM

Hi all,
just thought I'd add my two cents worth on the off-chance it's of some help to somebody.
First a bit of background...if you just want to read about the new treatment then just skip this paragraph. Myself...Type V separation from a motorycle accident more than 7 years ago, with conservative treatment (i.e. no surgery). have experienced the usual symptoms after healing - non-painful clicks and clunks on movement, achy discomfort when sleeping with that arm folded under, prominent bump worsening during cerain movements (particularly load-bearing) such that it becomes uncomfortable, asymmetry and instability when lifting weights. For those of you have tried weight training with this condition, you'll know that the 'falling out of shape' of the shoulder structure during can be disconcerting at best and sometimes even painful, as if the entire stucture is about to blow apart ; I have also on a number of occasions suffered strain injuries to various muscle groups attaching to the area, not surprising given that it is the muscles on the injured shoulder that are now completely taking the torsional load in the absence of the ligament structures - as I'm sure you all know, Grade III and above means that the ligaments that anchor the clavical and keep the whole acromioclavicular joint (and accordingly the shoulder structure in general) stable are severed competely - I'm afraid these never grow back. After a number of years weight training, I can say that while my strength has steadily improved, it is not approaching (and I believe never will) pre-injury levels, and an important contributing factor is the impact on 'form' - the all-important technique in performing weight exercises. Prior to failing prematurely during sets (failure unfortunately not because of the desired work of the isolated muscle group but because of structural weakness and discomfort), form falters badly, with action and control compromised significantly on the injured side. I feel that there is well above average development in the muscles surrounding the structures in my injured shoulder; it seems however that (at least for me) the sad reality is that these muscles cannot come close to re-creating the stability of the original structure, and nothing exposes this instability more than the leverage created by brandishing a heavy weight at arms length.

So on to the topic of surgery...as some of the posts on this site point out, the default treatment for even severe AC joint separations is conservative, not least because of the poor success rate of these surgeries - for example, the Weaver-Dunn procedure mentioned elsewhere on this site (involving the grating of tendons and muscles from the leg, often with synthetic sutures to strengthen the grafts) is cited as having only a 50% success rate, and even "successes" frequently have ongoing flexibility issues. On balance, the outcome does not justify the surgery when compared to just leaving the damn thing as it is, so you just put up with it for life.
However, there now seems to be a ray of hope.
Thought you might all be interested (as I certainly was) in the following procedure pioneered at Nottingham Shoulder Unit here in the UK back in late 2001, and recently being adopted by shoulder units elsewhere; it is accordingly apparently known informally as "The Nottingham Procedure". It involves the "lassoing" of the coracoid (a hook-like sutructure on the scapula) with a loop of Surgilig (a braided synthetic ligament material), attaching the other end of the Surgilig to the clavicle by means of a permanent screw on the top side of the clavicle, then tightening the Surgilig to draw the clavicle down and anchor it near it's pre-separation position. Beyond being strong and permanent, the open weave of the Surgilig is conducive to fibrous re-growth, meaning it acts as base on which your body lays down it's own organic material, enhancing further it's integrity and permanence. It is worth noting I think that it does not aim to precisely re-create the original structure - the single Surgilig proxies for the two torn acoclavicular ligaments that anchored the collar bone previous to the separation; further, the acromioclavicular joint itself (effectively a lump of cartilege butting together the ends of the clavicle and the acromion, sheared off completely in type III and above separations) is NEVER restored - in fact, about a centimetre is sawn off the end of the clavicle during the Nottingham Procedeure, specifically I presume so that they will NOT meet and grind together (incidentally, screwing this joint back together as asked about by a contributor elsewhere in this forum is NOT an option; the aforementioned sleeve of cartilage around a normal AC joint is by necessity flexible, and fusing the ends of the acromium and the clavicle would have dire consequences for the functionality of the shoulder).
It seems that this procedure has produced good results in terms of re-establishing stability, and with few reports of complications thus far. It is even reported that in cases where the screw has had to be removed, the Surgilig has still held due to the fibrous regrowth.
For those of you who are not squeamish about the odd surgery photo, here is a link with a very good summary of the new procedure, published in October 2005:
http://www.opnews.com/articles/138/articles.php#3
And here is one example of a shoulder unit here in the UK that has now adopted the procedure:
http://www.shoulder-info.com/ACROMIO_CLAVICULAR_JOINT_DISLOCATIONS.htm

I plan to see my consultant within the next month or so to explore this further, and specifically to gain an indication of how the screw anchoring the Surgilig will stand up to heavy loads. Will leave another post when I find out more.
In the meantime, if anybody else knows anything more about this procedure, either personally or through research, would love to hear about it.
Cheers,
Marc
London, UK (previously Sydney)

Marc

13-06-2006, 07:38 AM

Further to my previous post, here is the URL that for some reason was truncated:
http://www.shoulder-info.com/ACROMIO_CLAVICULAR_JOINT_DISLOCATIONS.htm
Also please forgive all my spelling mistakes, particularly the "it's" for "its"...really shouldn't write late at night and then post without proofing.
Marc

plucs

13-06-2006, 09:29 AM

Hi all,
So on to the topic of surgery...as some of the posts on this site point out, the default treatment for even severe AC joint separations is conservative, not least because of the poor success rate of these surgeries - for example, the Weaver-Dunn procedure mentioned elsewhere on this site (involving the grating of tendons and muscles from the leg, often with synthetic sutures to strengthen the grafts) is cited as having only a 50% success rate, and even "successes" frequently have ongoing flexibility issues. On balance, the outcome does not justify the surgery when compared to just leaving the damn thing as it is, so you just put up with it for life.
However, there now seems to be a ray of hope.

From the shoulder specialists I saw, they told me their success rates for modified weaver dunn were 75%, and for serveral others 95%.

The hamstring autograft is done only if the shoulder autograft has already been done.

I have no flexibility issues and I was not told by the specialists that it could be a problem. Working diligently with a physio after the operation ensured that my ROM is as good as my good shoulder.

I'd still always take the risk and cost of surgery especially if the injured person lifts heavy objects regularly.

There is hope, and it does not just exist in England. We have very shoulder speciaslists here.

Gareth

15-06-2006, 02:26 PM

Hey me again,

Marc I think that the operation you are talking about is the one that I had, as the shown x ray on the referenced site is almost identical to mine. Just under six weeks post operation now I am feeling very positive and have started my rehab, I am already actively lifting weights to strengthen around the joint and have already even performed light shoulder pressing exercises, with almost non existant pain. I have had a false ligament put in where it is looped through itself around the shoulder and then pinned at the front on the end of the ac, with the end of the ac also being excised scar tissue also forms across the gap at the end thereby recreating the effect of the original ligaments. With regards to its strength my surgeon / specialist is extremely confident of it, choosing it over a pin or plate procedure in active athletes argueing that it stands up better. My flexibility is also good with my physio being amazed at the progress that I have already made in this and strength. My flexibilty is almost back to normal and as I have won national honours in my younger years in swimming it was a previously subtle joint pre injury.

My surgeon is very competent being an upper limb specialist who was also involved in the development of this ligament, and with its results so far I have every confidence in it and him. As formentioned I now play rugby and lift heavy weights almost everyday (pre injury) and I have little doubt that for heavy impact and strain I have been given the right operation in my surgeons eyes, and from my post operation experiences, in mine. He has told me that I can do almost anything from here on in, only obviously taking it easy to start with and building up gradually. He has only told me to avoid very heavy strain ie 1 rep max or max or heavy sets for another 6-7 weeks (3 months post op) in order for the complex fibrous proteins such as collagen to form increasing the strength, then I am completely off the leash to my delight. I was worrying and asking many questions in my post op appointement and he said you will be able to do everything, I quote "It will be strong".

I too like plucs would obviously (as I have) take an operation no matter the risk or cost, because ultimately the way I see it, it cannot be worse than before because I couldnt do what I wanted to do before which was lift weights. Now already I can do more than I could 9-10 weeks post injury and I havnt even got anywhere near pushing it yet even to its capabilities at this stage, and there is still a lot of strengthening of the joint to go and only this week I have started the muscle building around the joint so it is still miles away from its hopefully impending strength.

Sorry its a bit long but I had a lot to stay and Marc I hope it answers some of your questions. I also look foward to hearing from you and others on this and other operations, or other peoples experiences with or without out op or whatever. I also apologise if anything I have said is wrong for I am no doctor, just an enthusiastic amateur.

Gareth

hazestang

11-07-2006, 08:54 AM

I just wanted to thank you all for the posts. I have been pretty nervous the last week or so. I have a grade III as well. It happend 16 years ago and never bothered me until I started getting heavy into combatives while in Iraq. Now it is uncomfortable on a daily basis. Not sure which one they are doing on me, but I definately have a bunch of questions for the doctor tomorrow. I will keep you all posted, and thanx again.

Bill

slucatero

12-07-2006, 12:11 AM

I too would like to say thanks, especially to plucs for keeping us posted on his progress. It's helped me understand what I can look forward to in the coming months. I got the Weaver Dunn surgery on 16 Jun and it's coming along pretty good; I can do most movements that don't involve moving my hand behind my body or higher than my chest. I do have a question, though, occasionally I get sharp pains when I bend down quickly or im getting out of bed. It's not a lasting pain but it does worry me. I also get it when I am sitting down and go from a leaning back position to more of a forward slouch...anyone else go through this? I am about 3 1/2 weeks out of surgery and wear the sling about 60% of the time, I take it out whenever I am not going to be moving around much like when I type, hang around at home, or sleeping. Any advice would be very appreciated, thanks.

Rodrigox

12-08-2006, 03:59 PM

Have a question, i used to lift weight a lot and after 3 years of doing it i got a terrible pain on my shoulders, i quit lifting for about many months later, but cuz im a automotive engineer i gotta keep doing lots of force assembling engines and it causes me a lot of pain, after all this months i havent get to a doc to see what happen and i also think i had a cronic injury and pain cuz of it, but a week ago i went to some traumatologyst and he told that i was born with shoulder instability and then he told me that i cant go back to weight lifting, but i didnt believe it so..., he sent me to physical teraphy and to rehabilitate my shoulders and perhaps after that i could choose a different sport like swimming or something related, but i really wanna get back to weight lifting, might someone knows if after getting teraphy and getting enough strenght at my shoulders may i could get back to gym and recover my muscles back? or what do u recommend.. if theres a way to correct that problem, i would really appreciate your help.

Thx

Rodrigo

mantisgb

15-08-2006, 08:50 PM

I thought I would just mention that I'm in week 4 following a Nottingham Surgilig reconstruction. I had a type III dislocation 3 years ago, and after a year of chronic pain I decided to find out what my options were. The GP referred me to an ortho-surgeon who suggested the next step should be the Weaver Dunn procedure. I asked at the time if he had heard of artificial ligament based approaches to reconstruction of the AC joint and he said yes but would like to go ahead with Weaver Dunn in the first instance. To cut a long story short, the Weaver Dunn failed around week 3 the screw came out of the Coracoid Process and left me in massive pain - ultimately the screw was removed and my shoulder went back to moderate pain whenever I played Badminton. I left it like this for 2 years but decided I wanted to have another go (after the failed WD procedure, and the pain of a screw coming out of the bone I assure you this wasn't undertaken lightly). I saw a different surgeon this time who specialised in shoulder surgery. PLEASE TAKE NOTE I did not find out that my first surgeon actually works mostly on wrists - it is CRITICAL that you quiz your surgeon about the procedure, how many he has carried out, what his success rate is and what other surgeons do. I was more annoyed that the first surgeon did not tell me at the first referral appointment that another consultant in the same hospital would be much better placed to assist. :-(

Anyway, back to the Nottingham Surgilig. I have the arm out of the sling all the time, I can drive (though changing gear is a little sore) and do most things and I have much more mobility in my shoulder than I did following the WD procedure the first time, although, arguably this could have been due to the failure of the screw. I asked my consultant what the strength of the surgilig was and he was pretty forthright - reckoned I could hang a lump of concrete (his words! How big a lump I thought...) from my arm and the reconstruction would hold. Needless to say I'm not going to try that!

I'm due at my first physio appointment this afternoon with instructions to show them this photograph:
http://www.ellisdev.co.uk/clavicul.htm

as my surgeon didn't think many physios would be familiar with the procedure.

I'll update as time goes on but I'm already 100% happier following this operation than my first.

cheers, Keith

thomas

18-09-2006, 03:39 AM

your situation sounds very similar to mine. i have a grade 3 a-c seperation which happened about 3 years ago. i have developed chronic pain in the last 6 months. the pain varies alot mostly its just a dull ache. i recently saw a couple different orthos with the last being concerned with loss of ROM with the surgery. since i have better ROM with the injured shoulder than the normal one. so my question is how was your ROM prior to your op?i would appreciate your thoughts and all the info i could get from anyone in the same situation. thanks

Hi Cookie,

I was in the same situation as you at one year post my grade 3 ac joint dislocation. Later in the second year is when I developed chronic pain. Chronic pain for me was pain in most days of the week at varying levels with the worst forcing me to not move my shoulder.

I also had surgery, outer clavicle excision modified weaver dunn shoulder reconstruction on the 22 September 2005. I wish I had the surgery earlier so I believe you made the right decision.

In terms of results you won't really know until you take your arm out of the sling in week 6. I would not stress too much before week 6 as your orthopaedic surgeon will have fixed the structural problems in your shoulder. It is easy to stress but you will be doing yourself no good. Just protect your shoulder and watch a lot of TV, DVDs, read and keep relaxed in the first 6 weeks.

In week two you will get your stitches out. If your wound has not healed fully when the stitches come out make sure you pay careful attention to it. If the wound is not healing you should expect to visit your GP for advice and possibly antibiotics to clear up the wound. The immediate results of the operation will be a vertical scar running across the top of the end of your clavicle. It should be around 3.5 - 4 inches. Your clavicle will be better aligned so there will be a large reduction in any bump.
In week 6 when you get your shoulder out of the sling there will be a lot of muscle wastage around your shoulder and bicep since you will not have moved your arm for 6 weeks. Your shoulder will not move very much as the shoulder becomes compartmentalised. You can compare this will the mobility you have in your good shoulder if you attempt to move it in the direction of the compass points. After week 6 your shoulder will improve daily but it will take a lot of work on your part to keep moving. You will need to find an experienced physio who has worked with similar repairs. Expect to work very hard on your rehab. You will initially focus of your range of movement and then strength.

I wish you all the best mate. Just be sensible and remain positive.

plucs

18-09-2006, 01:31 PM

your situation sounds very similar to mine. i have a grade 3 a-c seperation which happened about 3 years ago. i have developed chronic pain in the last 6 months. the pain varies alot mostly its just a dull ache. i recently saw a couple different orthos with the last being concerned with loss of ROM with the surgery. since i have better ROM with the injured shoulder than the normal one. so my question is how was your ROM prior to your op?i would appreciate your thoughts and all the info i could get from anyone in the same situation. thanks

My ROM before the surgery was normal.

My ROM 3 months after the surgery was back to normal which included 6 weeks of rehabilitation.

ajohnston

06-03-2007, 01:32 PM

5 weeks ago I sustained a level 5 AC separation snowboarding and have decided to have surgery. Yet, I am confused because my doctor has given me two options for surgery. 1 is the modified weaver-dunn using my own ligament or using a cadaver instead. Does anyone have advice as to which one I should do?
Also, I am an avid mountain biker and I was wondering if any mountain bikers have had the surgery and how long does it take to get back on the bike? My doctor has been telling me 4 months (that puts me into July!!!!!) but I am wondering if maybe that is a conservative estimate?
Any advice would be helpful.
Thanks

hopeful

07-03-2007, 05:20 PM

i havent had surgery, but i would say to be back to 100% it would take alot longer than 4 months. you can probably ride a bike with confidence after 4 months but serious mountain biking would take at least 8 months.

Footypunter

24-04-2007, 09:34 AM

I have also been a heavy weight trainer for over 15 years and I separated my left shoulder many years ago and just trained through it with the help of cortisone til it returned to almost normal ROM and the pain went away. The bump is of course still there.

I have now separated my right shoulder much more severely and rested it for nearly 2 months, but, it only got worse. I then started doing some weights and it got better, but, I then slipped 2 discs in my back and have had another 6 weeks off from weight training and the shoulder although fairly pain free continually clicks whenever I move it. The bump is quite severe and I would say from looking at pictures it is also Grade 3.

I am currently seeing a physio for my back problem and mentioned my shoulder, but, apart from some manipulation of the AC, they haven't suggested anything.

When I told them I had separated my shoulder, they kept talking about a dislocated shoulder and sublaxation, which, unless I'm mistaken, is something completely different.

Can anyone reccommend any shoulder exercises for this injury or a spe******t to see in Melbourne???

hopeful

24-04-2007, 05:16 PM

its definitely not a dislocated sholder but the word subluxation is a grey area.

subluxation just mean the bones have moved out of place which aplies to both dislocation and ac separation. it seems u know a fair bit about the injury anyway since uve done it twice.

have a look in a thread i started titled 'rehab for shoulder' and there are some suggestions there.

angieliu

25-04-2007, 11:55 AM

I have also been a heavy weight trainer for over 15 years and I separated my left shoulder many years ago and just trained through it with the help of cortisone til it returned to almost normal ROM and the pain went away. The bump is of course still there.

I have now separated my right shoulder much more severely and rested it for nearly 2 months, but, it only got worse. I then started doing some weights and it got better, but, I then slipped 2 discs in my back and have had another 6 weeks off from weight training and the shoulder although fairly pain free continually clicks whenever I move it. The bump is quite severe and I would say from looking at pictures it is also Grade 3.

I am currently seeing a physio for my back problem and mentioned my shoulder, but, apart from some manipulation of the AC, they haven't suggested anything.

When I told them I had separated my shoulder, they kept talking about a dislocated shoulder and sublaxation, which, unless I'm mistaken, is something completely different.

Can anyone reccommend any shoulder exercises for this injury or a spe******t to see in Melbourne???

KJ seems to know a lot of good sports physios and sports doctors in Melboune. KJ can you help with this one?

PrideH

14-05-2007, 09:36 AM

Is anyone aware of a doctor or clinic that performs the "nottingham procedure" with the Surgilig prosthetic ligament in the US? From the research I've done, Weaver-Dunn seems to still be the operation of choice among American physicians.

hopeful

14-05-2007, 04:48 PM

more importantly, you should be querying if the arthroscopic weaver dunn is now available anywhere

kjwilkin

14-05-2007, 05:01 PM

KJ seems to know a lot of good sports physios and sports doctors in Melboune. KJ can you help with this one?

Hi there,

I would recommend Ian Macindoe as a top shoulder physio. He works at Olympic Park Sports Medicine Centre. The number for Olympic Park is 9427 0366. I have been seeing Ian for a couple of years and has really helped me. You are much better off seeing someone that specialises in shoulders. He also specialises in backs too.

There are a number of really good sports physicians at Olympic Park. Some of these are Andrew Jowett, Paul Blackman, Chris Bradshaw and Tim Barbour. I see Andrew Jowett and has been really good in coming up with ideas re my shoulder.

Last week I had my shoulder operated on by Greg Hoy and would highly recommend him. The number for his rooms is 9525 1833.

I would suggest you start off seeing a sports physician first. Then they will be able point you in the right direction.

Good luck !!

MK87

02-11-2007, 04:39 PM

Hello everyone,

Im another bodybuilder/strength trainer, and recently as I was progressing to heavier and heavier weights, I noticed some pain in my shoulders. I thought at first that it was my rotator cuff, but went to my physician and he told me it was an AC seperation. Now mind you, this is pain in both shoulders. Anyways, he told me to take 2 weeks off, and I am due back at the gym in a few days to see where Im at. My concern is that he seemed to do a bit of a rushed diagnosis, and neglected to tell me the severity of the seperation. There is no external bruising or visible deformities (none that I can really see anyways), and a couple days after my last workout, movement pain in my shoulders seemed to subside. However, I am left with this strange clicking/grinding/popping in my shoulders when I move them in some ways. Could this be a grade 3 seperation, or is it somewhere in the grade 1-2 range? Also, what causes the clicking/popping noises? There is very mild pain when I do rotator cuff warm-up excercises.

Imbolc

09-11-2007, 08:24 AM

Hey Mike and Administrator.

I am also suffering a seperation of the AC joint which I can only put down to doing weights. My saga - Before I knew what it was I just hoped the pain would go away but eventually went to a Dr when it was getting harder to do my usual exercises. They Dr diagnosed me with rotator cuff. I waited about 6-8 weeks until I got into physio. After 6-8 weeks of physio - theraband - I realised that I wasn't getting rid of the pain so asked for some sort of scan be done. The Dr's surgery - which I should say is a clinic where you wait and see one of a multitude of Dr's - suggested I have an ultrasound. A week later I go back to have the scan read. The Radiologist has found a small separartion but the Dr suggests I have an X ray. The radiographer askes if I play contact sport - no. Have I had an accident? - No. I take the scans to the physio who brings a collegue in - have I fallen off the bike - no. Am I aware this is a trauma injury and is the result of an impact? No I can't think of such an incident. I suppose I'm trying to highlight that this seems to be a bit of a misunderstood injury, at least for the 'cause' even in the medical profession. The other thing I'd like to say that isnt going to make you feel any better is that I have what they are saying is a Level 3 without snap. I'm trying to work out how to post my X ray. I have had this for now over 4 months and it's not getting any better. I dread the thought of surgery and live on anti inflamatories which I hate taking. I look forward to how you go. Please keep us posted. I can't get into the surgeon until January 2008 and by then my injury will be the best part of 8 months old. I'm 'not' doing push ups, chest flys, shoulder crunches or almost anything to do with the traps, lats or delts. I do minimal shoulder raisers (front or side) but I'm down from 8 & 9 kilo (I'm a fem) to about 3 kilo, and then only now and then. The Rotator cuff muscles are looking fab but otherwise, I'm watching the definition I had slowly disappearing. The old muscles have memories is keeping me in there though & I hope if and whn I get this sorted I'll be back at it. As I say good luck and keep us posted.

tru

15-12-2007, 11:12 AM

Hi, I've just searched google for shoulder seperation and this was one of the results.

Having read some of the posts here from others I've got a general idea from what to expect from my injury and wanted to help some others.

Just over 5 weeks ago now I received a Grade II shoulder seperation playing football (soccer). As much pain as I was in, and the inability to take my tshirt in under 5 minutes or wash under the opposite armpit, I went out that night (I'm a university student!!) :D someone managed to bear hug me side on that night and pick me up in the air, oblivious to my screams of pain that were being drowned out by the music, Im sure it didnt help matters lol.
Having gone to the hospital the next day as my shoulder was now massively swollen I got told 'you've sprained your shoulder or something'(!!) by the hospital Doctor and given ibuprofen and a sling. Now I knew I had weak rotator cuffs (through self-diagnosis after my GP couldn't tell me what the clicking in my shoulders was when I was in the gym) so I headed to my Uni GP the same evening where I was diagnosed with a Grade II shoulder seperation.

As any other gym goers or serious athletes know its very hard to lay off. After four weeks I gained full ROM without pain, however in the gym I was restricted to pinless (pin out/no weight) smith shoulder presses and smith chest presses with the injured arm.
Through this lay off I've lost over half a stone in weight.

FOR ANYONE THAT HAS HAD SHOULDER SEPERATION.....
Please, please carry out some rotator cuff exercises, click here (http://familydoctor.org/online/famdocen/home/healthy/physical/injuries/265.html). Use LIGHT weights. And no matter what you do, even if you feel like you're ready to get back into the gym and lifting heavy again, if it hurts, it isn't ready.

tru

15-12-2007, 11:17 AM

Oh and even if you haven't seperated your shoulder you should be doing these exercises anyway - I'm 90% sure had I carried them out when my shoulders started clicking in the gym I wouldn't have seperated my shoulder in that football game!

hello_123abc

13-01-2008, 11:19 PM

Hi had a grade 3 AC seperation from a mountain bike accident have decided to have surgery is the Nottingham Surgilig procedure available in melbourne???

Hype898

14-01-2008, 06:35 AM

I have had three surgery now. The first was an arthroscopic, The second was open surgery to fix the ligments and tighten the capsoul. The third surgery i am currently recovering from. It was an open surgery that used cadaver parts. They used an ankle bone and achiles tendion to create a " Bone Block". It has been five weeks since surgery and i have no range of moution what so ever. I know this surgery was more of a major surgery than my others, but i am really starting to get worried.
is this normal?

Another random question has anyone applyed for disabilty and had any sucess?

pgp

13-12-2010, 12:22 AM

Gareth,
I have a Grade 3 AC dislocation. Similarly like weight lifting. Injury 3 1/1 months ago - September 2010 . Shoulder still very unstable when attempting bench press. With your surgery "false ligament pinned in between the joint which remains in, and is helpful to get you bac to sport quickly"- how did it go? This is an old thread - how is your shoulder 4 years on? Are you back lifting to where you'd like to be?

yahoosbingos

10-02-2011, 03:48 AM

You're right, and this correction - should be non-surgical. Although the general pattern to follow, each of the A / C damage is different, so see how you pull up, if you are not too bad, avoid surgery, but if you have chronic pain or weakness, plastic surgeon to discuss it.

Vindiesel

28-04-2011, 06:06 PM

Hi,

I had grade III shoulder separation two weeks ago. As a hobby I lift weights actively. E.g. I have made 400 in bench press, 330 in incline bench press and 240 in military press. I think I try to rehabilitate the shoulder first without surgery.

Does somebody have experiences of how well it is possible to recover the original strength level after this injury?

How much time it is going to take to recover fully?

Does the separation cause some kind of permanent unfunctionality to the shoulder so that it is not possible to gain the original strength level back?

Should surgery help the recovery?

I have read few studies of how recovery has gone after this injury and it seems that without the surgery the recovery process is faster and you are able to gain the original strength level quite well back. But I understood that those studies were made with patients that didn't lift weights actively.

The answer to your first question,I don't have the similar experience but I have noticed a few people.
Regarding your second question,The Rehab process is long and you needs to be more patient.
Last one,Surgery is a good solution but It too requires plenty of time to fully recover.

jus10ab

28-05-2011, 06:13 AM

I got a type III separation about 10 years ago in hockey. I had no idea that shoulder separation would be a seemingly unending frustration. I've lifted weights since before the separation and continued lifting afterwards. I'm not sure what kind of methodology I used to lift weights with; all I can say is it wasn't overly effective. I got used to ignoring the pain in my shoulder and didn't move it through a very large range of motion since separation. The problem that I am coming against is that weight lifting isn't just a recreational activity like any other as it used to be for me. I started lifting weights again about 6 months ago...I lift every day...for hours...there's nothing I like doing better. As the amount of weight I lift goes up constantly, I become more aware of the pain & monitor it because I have a constant concern that it will just collapse. I have put on 50 lbs of muscle in 6 months...my arms are heavier...my shoulder really hurts. When I'm deadlifting 335 lbs or incline benching 225 lbs or doing a t-bar row with 245 lbs and so many other things...I wonder...should I really be doing this? I can't stand always feeling that I am not aligned and since my shirts and jackets have gotten tight, I notice the difference between my two shoulders all the time. Some people tell me I shouldn't lift heavy weight like I do or not lift weights at all. I don't think that sounds reasonable, I can't stop living because of shoulder separation. It's always on my mind lately...I worry my shoulder will stop working...I don't like the way it feels...I don't like the way my clavicle sticks out and my shoulder drops off more sharply. I feel fed up because I just want it to be like my other shoulder and the vast majority of people have no appreciation for the fact that they have two unseparated shoulders. I'm 26...I just want it to be fixed...but I don't know if it ever will be. As some other people wanted to know...yes you can lift weights and make strength gains just as effectively good shoulder vs. separted shoulder...should a person with a separated shoulder get addicted to heavy weight lifting? I don't know. I'm always looking at everyone else's shoulders to see if someone else has a separation. I always feel like I'm the only one. The damn thing works...but it's frustrating me so bad, it hurts, and I want it to be better. Also, there seems to be a slight asymetry accumulating throughout my upper body and I worry that if I continue to get even more muscular, then I may start to look obviously crooked. My shoulder has been on my mind all the time recently...at least I said something about it...maybe I'll feel a tiny bit better...AHHH!!!